FAH (Fumarylacetoacetase, P16930) — review notes

Core function (well established)

FAH catalyzes the fifth and final step of the cytosolic L-tyrosine (and L-phenylalanine)
catabolic pathway: hydrolysis of 4-fumarylacetoacetate to fumarate + acetoacetate.

Direct experimental support for catalysis (human enzyme)

PMID:1998338 — TAS annotation to GO:0004334 (PINC). This is the human FAH cloning/expression paper; abstract-only cache but establishes human FAH catalyzes the FAA hydrolysis reaction and that the in vivo dimer is a homodimer.

Pathway placement / BP

Homogentisate catabolic process (GO:1902000, IBA)

Homogentisate (2,5-dihydroxyphenylacetate) is the intermediate produced by HPD from
4-hydroxyphenylpyruvate and consumed by HGD in the tyrosine pathway, upstream of FAH.
FAH acts on 4-fumarylacetoacetate, three steps downstream of homogentisate, so it is part
of the same overall pathway but does not itself catabolize homogentisate. The IBA is a
pathway-level (whole-pathway) grouping propagated across the FAH family; keep as non-core
(over-broad relative to FAH's actual biochemical step).

Disease (Tyrosinemia type I / HT-1)

FAH deficiency causes hepatorenal tyrosinemia type I (TYRSN1, MIM:276700), the most severe
tyrosinemia [UniProt DISEASE]. Loss of the terminal step causes accumulation of upstream
toxic intermediates fumarylacetoacetate (FAA) and maleylacetoacetate (MAA), and the derived
metabolite succinylacetone (SA). FAA triggers hepatocyte apoptosis via mitochondrial
cytochrome c release; SA inhibits ALA dehydratase (porphyria-like crises). Leads to hepatic
necrosis/cirrhosis, hepatocellular carcinoma risk, and renal tubular dysfunction. Treated
with nitisinone (NTBC, an HPD inhibitor blocking the pathway upstream) plus Tyr/Phe-restricted
diet.
- dismech Tyrosinemia_Type_I.yaml: "FAH deficiency leads to accumulation of toxic intermediates including fumarylacetoacetate (FAA), maleylacetoacetate (MAA), and succinylacetone (SA). FAA directly injures hepatocytes through mitochondrial cytochrome c release with caspase-mediated apoptosis."
- Apoptosis mechanism PMID:9305902
- Many disease-causing loss-of-activity missense variants documented (e.g. N16I, A134D, C193R, D233V, W234G, R381G) [UniProt VARIANT features].

Annotation-by-annotation reasoning